Rituximab was more effective than a second tumor necrosis factor-alpha blocker therapy in treating patients with rheumatoid arthritis after an initial tumor necrosis factor-alpha blocker failed, a study has discovered.
Researchers studied 196 patients (44 men) with rheumatoid arthritis and a Disease Activity Score 28 (DAS28) of at least 3.2 who had used a tumor necrosis factor-alpha (TNF-a) blocker. Patients were followed for more than 6 months after switching to rituximab (90 patients) or a second TNF-a blocker (etanercept, adalimumab or infliximab). Because it was a noninterventional study, treatments were not randomized and data was unavailable as to which therapy patients were assigned. Inadequate response was the most frequent reason (79.1%) for changing the first TNF-a blocker, followed by intolerable side effects (11.2%).
Patients using rituximab had a significantly lower DAS28 (−1.64; 95% CI, −1.92 to −1.36) vs. the cohort using the second TNF-a blocker (−1.19; 95% CI, −1.42 to −0.96) (P=.013). Patients who were seropositive for rheumatoid factor (−1.66 vs. −1.17; P=.018) and anti-cyclic citrullinated peptide (anti-CCP) antibodies (−1.75 vs. −1.06; P=.002) indicated even stronger differences. Thirty percent of the rituximab cohort showed good European League Against Rheumatism response compared with 15% of the second TNF-a group (22.2% vs. 34.9%, respectively, showed no response).
“The current study showed that anti-CCP positivity, in particular, could be a useful predictive marker of rituximab in patients with prior TNF-a blocker treatment failure,” the researchers concluded. “Further attention should be given to concomitant therapies, such as other [disease-modifying antirheumatic drugs] potentially influencing the response to biologics in different ways.”
Disclosure: The study was funded by Roche Pharma AG (Grenzach-Wyhlen, Germany).